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northeast iowa mental health & disabilities services ... - Fayette County

northeast iowa mental health & disabilities services ... - Fayette County

Form D: APPEAL PROCESS

Form D: APPEAL PROCESS FORM If the county makes a decision adverse to the individual, that person may appeal that decision. Adverse decisions may include decisions involving eligibility determinations, funding and/or service levels. The CPC Administrator makes initial decisions regarding eligibility for services. These Notices of Decision shall be in writing and shall explain the reasons for the decision. If a decision is appealable, the Notice of Decision will explain the right to appeal, and how to file the appeal. Step One: Filing the Appeal Applicants or their representatives (with consent of the applicant) may appeal an adverse decision by the CPC Administrator. The appeal must be in writing and must be filed with the CPC Administrator within fifteen (15) business days of the date of the decision. If the appeal is filed late, it cannot be considered. The appeal shall state the following: (1) the reasons why the CPC Administrator’s decision should be reversed; (2) the resolution requested: (3) applicant’s name, address, and telephone number and the name, address, and telephone number of applicant’s representative if applicable. Step Two: Discussing the Problem After the appeal is filed, the CPC Administrator will contact the individual to schedule a meeting to discuss the appeal. This meeting must be held within 10 business days, unless the parties agree to extend the time to meet. Individuals may bring someone along to the meeting to help explain the individual’s position. The individual and the CPC may ask another person to serve as a mediator. At the meeting, the CPC Administrator will explain his or her reason for the decision. The applicant may ask questions or give the CPC Administrator other information that is important. The individual must tell the CPC Administrator what type of outcome is desired (a proposed resolution). If the individual and the CPC Administrator reach an agreement, the CPC Administrator will issue a revised Notice of Decision within 10 business days. At the end of the meeting a revised Notice of Decision will be issued explaining the decision reached and whether the appeal will continue. Step Three: The Appeal If the parties are unable to resolve the problem at the meeting, within 10 business days of the date of the meeting, the CPC Administrator will contact a neutral decision-maker, an Administrative Law Judge at the Department of Inspections and Appeals, Iowa Code 10A.801 (Judge). The county shall pay the cost of the Judge. The Judge will set a prehearing conference to discuss hearing procedures and set a time for the hearing. The Judge will provide written notice of the prehearing conference and the hearing. The applicant will have the right to present evidence and argument at the hearing. The Judge will consider the evidence and will issue a written ruling. The decision of the Judge is final. Applicants may contact another person to assist with the appeal. This could be an attorney, an organizational representative, or a friend. The county will not provide legal assistance. Two places that may provide legal assistance include: Legal Aid: 1-800-532-1275 Iowa Protection and Advocacy: 1-800-779-2502 45

Form E: NORTHEAST IOWA COUNTIES CPC / COMMUNITY SERVICES COUNTY EXCEPTION TO POLICY REQUEST / NOTICE OF DECISION TO: Applicant’s Name: Client SS#: ###-##- _ _ _ _ Address: State ID: DOB: Please complete this form to request an Exception to Policy. Once the Exception to Policy request has been reviewed, the decision will be sent out to you and your service provider. Current Services Received: Agency Name Service Receiving Number of Units 46 Unit Cost Start Date Expected End Date Exception Being Requested: C P C U S E O N L Y Agency Name Service Requested Number of Units Policy to which the exception is being requested: Reason why the exception should be granted: Budget Impact: Unit Cost Expected Start Date Expected End Date Exception Requested By: Agency: If approved, Authorization start date: Authorization end date: Conditions of approval /other comment: Approved This service decision is an exception to policy. Central Point of Coordination Administrator Signature: Date: Approved pending available funds Date Approved Denied (Exceptions to Policy Requests are not appealable)

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